Advanced malignant solitary fibrous tumor in pelvis responding to radiation therapy

Solitary fibrous tumor (SFT) is a rare spindle cell neoplasm that is benign in most cases. Although SFT was first recognized to arise only in the pleura, recent reports indicate that SFT can involve a wide range of anatomical sites. To date, 17 cases of pelvic SFT have been reported. Herein is reported a case of a 74-year-old woman with a giant malignant SFT in the pelvis. Along with massive invasion to adjacent organs and multiple lung metastases detected on radiography, biopsy from the tumor through the vaginal wall showed malignant looking spindle-cell neoplasm with increased cellularity, areas of necrosis, and high mitotic activity (5/10 high-power fields). Immunohistochemically, the tumor cells were diffusely and strongly positive for CD34, CD99, and bcl-2. Based on pathological features and clinical presentation, diagnosis of malignant SFT was made. The patient received systemic and the intra-arterial chemotherapy followed by whole pelvic radiation therapy (50 Gy). Initial chemotherapies failed to control the tumor. Afterwards, improvement was observed radiologically and pathologically in the 12 months' follow up after the radiation therapy. This is the first report related to therapeutic remarks on advanced malignant SFT.

[Immunohistochemistry and surgical approaches in solitary fibrous tumor of the pleura]

Solitary fibrous tumor of the pleura (SFTP) is a rare, benign, slow-growing neoplasm that arises from the submesothelial cells of the pleura. Usually, resection of the tumor and adjacent structures are sufficient for resolution. Nowadays, videothoracoscopy (VTC) allows adequate access for the surgical treatment of these tumors. CD34 antigen positivity is a differential feature with mesothelioma. We present our experience with 15 patients with SFTP (nine women and six men) who underwent surgical resection in the last 12 years (10 thoracotomies, one sternotomy and four VTC). Only four patients were symptomatic at diagnosis. In our opinion, VTC is a less invasive diagnostic and therapeutic approach than thoracotomy that provides an adequate approach for the resection of SFTP in selected patients. Because of the malignant potential of this tumor, long-term follow-up is mandatory.

Solitary fibrous tumor of the urinary bladder: report of a case with long-term follow-up and review of the literature

Solitary fibrous tumor (SFT) is a neoplasm typically arising in the pleura. Yet, extrapleural cases have been described and are a common cause of diagnostic pitfalls, especially when met in unusual sites. We report the clinical and pathological features of a case of SFT arising in a rather unusual site, the urinary bladder, the seventh reported to date in the English literature and the first with long term follow-up. Differential diagnosis from other spindle cell neoplasms of the bladder can be problematic. Prognosis of this neoplasm is obscure and long-term follow-up is required for all cases of solitary fibrous tumor. Solitary fibrous tumor is a rare mesenchymal tumor of the urinary bladder, but should always be considered in the differential diagnosis of spindle cell neoplasms encountered in the lower genital tract.

Fine needle aspiration cytology of solitary fibrous tumours of the pleura

OBJECTIVE

To analyse fine needle aspirates from solitary fibrous tumour (SFT) of the pleura and to elucidate the cytological features unique to these tumours and differential diagnostic findings of benign and malignant SFTs.

METHODS

Fine needle aspiration (FNA) cytology slides from eight cases of SFT of the pleura, including six benign and two malignant SFTs, were reviewed. The subsequent histological slides were also examined.

RESULTS

Cytological diagnoses from six histologically proven cases of benign SFTs were low-grade sarcoma (one), non-small cell carcinoma (one), malignant tumour (1) and benign (three). Two cases of malignant SFTs were cytologically diagnosed as malignancy. The aspirates showed a varying degree of cellularity. Most smears were composed of single, scattered fusiform cells, and irregular loose aggregates of oval to spindle cells intimately admixed with dense collagenous stroma. Two malignant SFTs had a greater number of cells in clusters, and displayed mitotic activity, without significant cytological atypia.

CONCLUSIONS

The diagnosis of SFT may be suggested by a combination of cytological and radiological findings. The precise determination of malignancy for SFT, however, is not usually straightforward on the basis of cytological features alone. The findings of highly cellular clusters and mitotic activity in the FNA cytological smear can help differentiate malignant from benign SFTs.

[Solitary fibrous tumor of the pleura; report of a case]

An 81-year-old male appealed against a feeling of dyspnea, and consulted the hospital. The giant tumor discovered in the thorax and it was enlarging gradually for 7 years. The tumor shadow with a diameter of about 15 cm was noted in right lower lung field on the chest X-ray. A definite diagnosis was not obtained by the needle biopsy. The tumor was found to exist between upper lobe and lower lobe and pressed lower lobe at surgery. The tumor was completely excised with partial resection of the collapsed lower lobe. The tumor was 1,050 g in weight and 18 cm in maximum diameter. Pathological examination showed the irregular and plan-like arrangement of the spindle-shape cell. Immunohistochemical study revealed positive findings for bcl-2 and CD34, negative findings for desmin, ketatin, and alpha-actin. The tumor was diagnosed as malignant solitary fibrous tumor of the pleura due to highly atypical nuclear finding with an abundant nuclear fission or histology.

Pedunculated solitary fibrous tumours arising from the pleura

Solitary fibrous tumour (SFT) is one of the rare tumours which arise from visceral pleura. Klemperer and Rabin first described SFT as a distinct clinical entity among primary pleural tumoUrs in 1931. Approximately 820 cases have been reported in literature to date. The management of patients with SFT is complete resection of the tumour and follow up of the patient to detect any possible late recurrence. In the present paper, we report two cases of pedunculated solitary fibrous tumours of the pleura that appeared as a wandering chest nodule to which surgical resection undertaken at our hospital. The aim is to summarise our experience in the management of solitary fibrous tumour.

Fibrous lipoblastoma with 8q11.2 abnormality

A 3-month-old African American female infant had a rapidly growing lipoblastoma with a prominent fibrous component in the soft tissue of the left lateral knee, which recurred at 10 months. Cytogenetic analysis revealed deletion of 8(q11.2q13) with a 19(q12q13.3) insertion at that site, confirming that this is closely related to the conventional lipoblastoma. The presence of multivacuolated lipoblasts and the staining characteristics (no staining for CD99, CD34, or smooth muscle actin) distinguish this from the recently described lipofibromatosis.

Diagnosis of breast cancer using diffuse reflectance spectroscopy: Comparison of a Monte Carlo versus partial least squares analysis based feature extraction technique

BACKGROUND AND OBJECTIVE

We explored the use of diffuse reflectance spectroscopy in the ultraviolet-visible (UV-VIS) spectrum for the diagnosis of breast cancer. A physical model (Monte Carlo inverse model) and an empirical model (partial least squares analysis) based approach, were compared for extracting diagnostic features from the diffuse reflectance spectra.

STUDY DESIGN/METHODS

The physical model and the empirical model were employed to extract features from diffuse reflectance spectra measured from freshly excised breast tissues. A subset of extracted features obtained using each method showed statistically significant differences between malignant and non-malignant breast tissues. These features were separately input to a support vector machine (SVM) algorithm to classify each tissue sample as malignant or non-malignant.

RESULTS AND CONCLUSIONS

The features extracted from the Monte Carlo based analysis were hemoglobin saturation, total hemoglobin concentration, beta-carotene concentration and the mean (wavelength averaged) reduced scattering coefficient. Beta-carotene concentration was positively correlated and the mean reduced scattering coefficient was negatively correlated with percent adipose tissue content in normal breast tissues. In addition, there was a statistically significant decrease in the beta-carotene concentration and hemoglobin saturation, and a statistically significant increase in the mean reduced scattering coefficient in malignant tissues compared to non-malignant tissues. The features extracted from the partial least squares analysis were a set of principal components. A subset of principal components showed that the diffuse reflectance spectra of malignant breast tissues displayed an increased intensity over wavelength range of 440-510 nm and a decreased intensity over wavelength range of 510-600 nm, relative to that of non-malignant breast tissues. The diagnostic performance of the classification algorithms based on both feature extraction techniques yielded similar sensitivities and specificities of approximately 80% for discriminating between malignant and non-malignant breast tissues. While both methods yielded similar classification accuracies, the model based approach provided insight into the physiological and structural features that discriminate between malignant and non-malignant breast tissues.

Pathologic and MR Imaging Features of Benign Fibrous Soft-Tissue Tumors in Adults

Benign fibrous (fibroblastic or myofibroblastic) soft-tissue tumors are a heterogeneous group of fibrous lesions with widely varied anatomic locations, biologic behavior, and pathologic features. The four broad categories of fibrous proliferation are benign fibrous proliferations, fibromatoses, fibrosarcomas, and fibrous proliferations of infancy and childhood. The first two categories include nonaggressive fibroblastic lesions such as nodular fasciitis, as well as fibromatoses that demonstrate more aggressive biologic behavior (eg, desmoid tumors). In adults, fibrous tumors are among the most common soft-tissue lesions encountered in clinical practice. MR imaging can be useful for defining the intrinsic signal characteristics, size, and compartmental extension of these lesions. Histologic features of the tumor also may be depicted on T2-weighted MR images. Hypocellular fibrous tumors with dense collagenous components tend to have lower signal intensity on T2-weighted images than do lesions that are more cellular or that contain greater amounts of extracellular myxoid matrix. When interpreting MR images of soft-tissue masses in adults, radiologists should be aware of the clinical behavior, common sites of occurrence, and histopathologic and imaging features of the common benign fibrous soft-tissue tumors.

Solitary fibrous tumor of the lung: A case report with a study of the aspiration biopsy, histopathology, immunohistochemistry, and autopsy findings

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm of ubiquitous location. In addition to its classic presentation as a pleural-based mass, it can be encountered in a variety of other sites. A pleural-based lung lesion can be easily accessed by radiologic guidance for cytologic study. Several reports have described the cytologic findings of SFT at various locations, including the lung. However, diagnostic difficulties can occur due to unusual clinical, radiologic, atypical cytomorphologic, and histologic features. We describe a case of intrapulmonary SFT in which a false-positive malignant diagnosis was rendered on fine-needle aspiration biopsy and concurrent surgical core biopsy prior to radiofrequency ablation. The patient died of procedural complications, and an autopsy was performed. Retrospective study of the case, especially correlation of cytologic, histologic, autopsy findings, and immunohistochemistry results were helpful in correctly diagnosing the case as SFT. We are reporting this case with emphasis on avoiding diagnostic pitfalls by being familiar with the accepted cytohistologic features and appropriate immunohistochemical results.

A clonal t(8;12)(p11.2;q24.3) as the sole abnormality in a solitary fibrous tumor of the pleura

A case of solitary fibrous tumor of the pleura with the karyotype 46,XY,t(8;12)(p11.2;q24.3) is reported. Although rearrangement of 12q15 approximately 24 is a recurring abnormality in solitary fibrous tumors, rearrangement of chromosome 8 was previously unreported in these tumors.

Solitary fibrous tumours of the infratemporal fossa. Two case reports

INTRODUCTION

The solitary fibrous tumour is a rare neoplasm originally described as a pleural tumour. An increasing number of different locations are described in the literature. Among the extrapulmonary sites, head and neck can be involved and particularly the nose, the paranasal sinuses, the submandibular region, the parapharyngeal space and the infratemporal fossa.

MATERIAL

Two cases, one of a young woman and another of an elderly gentleman are reported, each presenting with a solitary fibrous tumour of the infratemporal fossa. In one case an antero-lateral, transcranio-facial and in the other, a transmandibular approach (without labiotomy) were utilized. In both cases complete excision of the lesion and good cosmetic results were achieved.

RESULTS

Both patients were free from the disease for 5 postoperatively.

CONCLUSIONS

To date, very few cases of solitary fibrous tumour of the craniofacial complex have been observed to enable an accurate prognosis. Thus, treatment and follow-up should be identical to fibrous tumours located in other areas.

Giant solitary fibrous tumour of the meninges: MR-pathological correlation

The authors present the clinical, MR imaging and pathological features of the largest intracranial solitary fibrous tumour of the meninges ever reported in the literature. This well-circumscribed dural-based tumour strikingly demonstrated two different solid components. The first one demonstrated a suggestive T2 hypointensity that strongly enhanced after gadolinium administration while the other showed more classic homogeneous T2 hyperintensity and mild enhancement. These two components were also identifiable on the pathological examination, allowing an interesting imaging-histological correlation. Differential diagnoses of this rare extra-axial lesion are discussed.

Tumeur fibreuse solitaire de la vessie

INTRODUCTION

A solitary fibrous tumor is a rare circumscribed neoplasm that was long known in the pleura and has now described in many organs and soft tissues. Prognosis is favorable after complete excision.

CASE

We report a solitary tumor fibrous located in the bladder of a 38-year-old man with dysuria and a palpable abdominal mass.

DISCUSSION

Solitary fibrous tumors are reported very rarely in the urinary bladder. They may mimic other nonepithelial tumors in this site. Diagnosis based only on pathological features is difficult. When complete excision is possible, prognosis is generally good. Outcome is more serious in approximately 10-20% of cases, and strict follow-up is required.

Solitary Fibrous Tumour of the Pleura

Solitary fibrous tumours of the pleura are rare tumours originating from the mesenchymal cells of the submesothelial tissue of the pleura. The tumours may present in a variety of ways, ranging from no symptoms, to local symptoms such as dyspnoea, cough and chest pain, through to systemic symptoms such as clubbing and hypoglycaemia. We present a case of a solitary fibrous tumour, which presented with clubbing.

A complex translocation (6;12;8)(q25;q24.3;q13) in a fibrous hamartoma of infancy

We report the case of an 18-month-old girl who came to medical attention with a left cervical mass. Surgical excision was performed 16 months later. Histology revealed a fibrous hamartoma of infancy. Follow-up has been uneventful, and no recurrence of the mass has been observed. Cytogenetic analysis showed a complex translocation involving chromosomes 6, 8, and 12, namely, t(6;12;8)(q25;q24.3;q13). This case represents the second cytogenetic analysis reported to date in fibrous hamartoma of infancy and reveals a different translocation than the reciprocal translocation t(2;3)(q31;q21) previously reported.

[Solitary orbital fibrous tumor in a 12-year-old child]

Solitary orbital fibrous tumor was diagnosed in a 12-year old boy admitted to hospital for right-sided exophthalmos. MRI revealed orbital mass and surgical resection was performed. Histologically the tumor was composed of round or spindle cells with a lot of multinucleate giant cells and pseudovascular spaces. The neoplasm was regarded as a mixoid type of a solitary giant cell-rich fibrous tumor. Immunohistochemical analysis revealed coexpression of CD34, CD99, bcl-2, and CD99 (mic-2). The most important clinical, morphological, and immunohistochemical manifestations are presented in the paper. Major criteria for the differential diagnosis of solitary orbital fibrous tumor and the similar soft tissue tumors are discussed.

Histologically malignant solitary fibrous tumor of the orbit

An intra-conical histologically malignant solitary fibrous tumor of the orbit presented in a 28 year-old female with intact vision and exophthalmos. Total resection was achieved by means of a frontal craniotomy and orbital roof osteotomy. Evidence of a beneficial role for adjuvant treatments in this particular tumor is controversial and vision impairment is a possible side effect. Therefore they were not employed. The patient is well after two years of follow-up.

Intermittent respiratory obstruction secondary to a solitary fibrous tumour

There have been fourteen cases of solitary fibrous tumour reported as originating from the paranasal sinuses. Here we report a case of solitary fibrous tumour that involved the right nasal cavity with extension into the oropharynx causing stertor and intermittent respiratory obtruction. Histopathology examination revealed the tumuor cells expressed CD34 turnout marker.

Malignant solitary fibrous tumor originating from the peritoneum and review of the literature

BACKGROUND

Solitary fibrous tumor (SFT) is a rare neoplasm frequently involving the pleura. Benign and malignant forms of the tumor occur, the benign variant being three to four times more common than the malignant.

CASE REPORT

We present herein a rare case of large malignant solitary fibrous tumor (SFT) originating from the peritoneum. An abdominal computed tomography scan revealed a well-defined solid tumor with mixed density. An abdominal ultrasonography (US) revealed a well-circumscribed solid tumor containing a partially cystic lesion. T1-weighted abdominal magnetic resonance imaging demonstrated a hypo- to isointensity, which was a hypo- to hyperintensity on T2-weighted images. Liposarcoma originating from the retroperitoneum was suggested, and the patient underwent a complete resection of the tumor as well as the left kidney because tumor invasion of the upper left kidney was suspected. Immunohistochemically, the spindle-shaped cells were positive for CD34, and the diagnosis was SFT originating from the peritoneum. At the 14-month follow-up evaluation, no recurrence or metastasis was detected.

CONCLUSIONS

This case gave us some difficulty, and the correct diagnosis of the peritoneal mass was valuable. To diagnose the malignant potential of this type of tumor accurately may have value to direct the appropriate therapeutic operations after surgery and postoperative progress observation.